Apraxia of Speech: Defining and Describing the Disorder

It’s Saturday night, it’s getting late (in Mom world at least), I’ve been taking care of two sick kiddos all day, but I just wanted to introduce a topic I’ll be talking about a lot coming up because it’s something we’re starting to work on everyday: Apraxia of Speech.

What is Apraxia?

It’s a motor speech disorder. What’s that? Speaking feels so natural but is actually a very intricate and complex process. A motor speech disorder means there’s difficulty with the motor planning part of moving your tongue, lips, etc. to execute the necessary sounds in the consonant-vowel combinations they need to be in to produce a target word. The words are in the child’s head, but the articulators have a hard time executing the movements to make those words.

What does Apraxia look like?

Here are some of the more common signs and symptoms:

  • delayed acquisition of speech/language milestones
  • very limited inventory of consonants or vowels a child is able to produce
  • difficulty producing multi-syllable words
  • atypical sound error substitutions and inconsistent use of those substitutions. Example: Most kids who can’t produce a /g/, substitute it with a /d/. That would be a typical substitution. If they make that /d/ instead of the /g/ every time, that’s a consistent error. If they can’t produce a /g/, but sometimes produce an /l/ or another sound or sometimes completely omit the target, those are atypical and inconsistent errors which are more concerning.
  • gap between receptive versus expressive language abilities, meaning a child can understand much more than they are able to express verbally
  • Groping: abnormal movements of the lips or tongue that make a child appear to be physically struggling to verbalize something
  • difficulties (sometimes extreme) with intelligibility

Is there a relation between Autism and Apraxia?

I am not a doctor, so I will just tell you some research statistics here. There is research that has come out in recent years that indicates a higher incidence rate of Apraxia of Speech in children with Autism Spectrum Disorder. That does not mean that having Autism means you have Apraxia or that Autism causes Apraxia. It just means that when you isolate a population of children who have Autism and another population of children who are otherwise typically developing, the group of children with Autism may have more children who have a true diagnosis of Apraxia versus the typically developing group. Dr. Cheryl Tierney, M.D. published a paper in the Journal of Developmental and Behavioral Pediatrics in 2015 that found that 64% of children who had a diagnosis of Autism Spectrum Disorder in her clinic also met the diagnostic criterion for Apraxia of Speech.

Do I have a two cents on it? You know it. I always thought….even before I zeroed in conclusively on Autism…..that Caleb may have Apraxia. He was really young and it’s so difficult to label accurately at that age, but I like to think that I am very good at my job and that I know my child very well, so it most definitely was brought up to my colleagues and his pediatrician as a possibility. Now that he is becoming more verbal on a daily basis, the fact that he is having such  a hard time coordinating that little mouth to say what I ask him to say is glaring to say the least, really.

There’s lots more I can go into about how Apraxia of Speech can be addressed therapeutically, the importance of tactile cues, etc…..but I’d be here all night and it would be overwhelming. What I would like to leave you with is the first step of what you should do if anything that you read above alerts you to red flags in your child: talk to your child’s doctor and get a script for a referral to a speech therapist. Therapeutically, for myself as a professional, it’s very important to me to determine if a child does in fact have Apraxia of Speech because whether or not it is present will absolutely dictate how we go about intervention and the order that I pick targets to work on. 

Here are some things that I WILL leave you with though!:

  • Check out some infographics and links to articles on the “Take That, Autism!” Apraxia Pinterest Board.
  • “Take That, Autism!” also has a YouTube channel now! Here are some links to a couple videos of Caleb so you can hear an example of severe apraxia. Listen for the decreased use of consonants, extreme difficulty with anything more than one syllable, limited intelligibility, etc. Some attempts sound like babble or just a vocalization as a place marker but hey…..we’re getting there. And one day, with the most intelligible speech he can muster up, Caleb’s gonna post a video on YouTube hollering “Take That, Apraxia!” Here are the links:
  • Don’t forget to follow us on Instagram @take_that_autism. Caleb has a sweet video that’s a good example of his speech abilities while he “reads” The Very Hungry Caterpillar on there.

Let me know if you have any questions! Catch me at ErinSamsell@takethatautism.org